Table 3.

Preventive and treatment strategies in preeclampsia/eclampsia

InterventionEvidenceBenefit(s)Quality of DataComments
Calcium supplementation13 RCTs, 15,730 women analyzed by a Cochrane review (97)RR, 0.45 (95% CI, 0.31 to 0.65) (97)HighHigh-dose calcium (>1 g/d) reduced the risk of preeclampsia in subgroups with low calcium intake of <1 g/d and women at high risk of preeclampsia
Vitamin C and E supplementationMulticenter RCT involving 1877 women (98)RR, 1.20 (95% CI, 0.82 to 1.75) (98)HighPatients were given 1000 mg vitamin C and 400 IU vitamin E; associated with low–birth weight babies (54)
Multicenter RCT involving 2410 women (54)RR, 0.97 (95% CI, 0.80 to 1.17) (54)
AspirinMeta-analysis of 34 RCTs involving 11,348 women (99)Before 16 wk of gestation: RR, 0.47 (95% CI, 0.34 to 0.65); after 16 wk of gestation: RR, 0.81 (95% CI, 0.63 to 1.03) (99)High (99); fair to good (100)Reduction in preeclampsia, especially if used before 16 wk of gestation in high-risk women
Meta-analysis of 13 RCTs involving 12,184 women (100)ARR=2%–5% (100)The USPSTF Study suggests that low-dose aspirin in high-risk women has important benefits when used as early as the second trimester
UFH and LMWHMeta-analysis of 10 RCTs involving 1139 women (101)RR, 0.43 (95% CI, 0.28 to 0.65) (101)Fair to goodSignificant reduction in secondary outcome of preeclampsia in high-risk patients; significant reduction in risk of perinatal mortality, preterm birth before 34 and 37 wk of gestation, and infant birth weight <10th percentile; it was not possible to evaluate the effect of UFH compared with LMWH
Magnesium sulfateRCTs ranging from 1687 to 2138 women (102,103)0.009% versus 0% of phenytoin versus magnesium to prevent eclampsia (P=0.004) (102);HighSignificant reduction in the incidence of initial and recurrent seizures in women with gestational HTN compared with use of anticonvulsants, like phenytoin and diazepam
52% lower risk of recurrent convulsion than diazepam (95% CI, 64% to 37% reduction); 67% lower risk of recurrent convulsions than phenytoin (95%, CI 79% to 47% reduction) (103)
  • RCT, randomized, controlled trial; RR, relative risk; 95% CI, 95% confidence interval; ARR, absolute risk reduction; USPSTF, US Preventive Services Task Force; UFH, unfractionated heparin; LMWH, low molecular weight heparin; HTN, hypertension.